Abstract A clinical profile of non-traumatic rhabdomyolysis with acute renal failure is presented. Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed. [ncbi.nlm.nih.gov]

Profound hyperuricemia was present in most patients. Transient hypercalcemia developed during the diuretic phase in 5 patients. One patient died. [annals.org]

• Weakness

  The classic triad of symptoms includes muscle pain, weakness and dark urine, although more than 50% of the patients do not complain of muscle pain or weakness. [ncbi.nlm.nih.gov]

  Muscle disorders can cause weakness, pain or even paralysis. [icdlist.com]

  The muscle damage causes inflammation leading to tenderness, swelling, and weakness of the affected muscles. [medicinenet.com]

• Collapse

  • Following the collapse of a building, seven subjects (aged 18 to 41 years) were released from under the rubble within one to 28 hours. [archinte.jamanetwork.com]

  During the extrication of an injured person from a collapsed building, wrecked automobile, or other site, isotonic saline solution should be infused at the rate of 1.5 liters per hour as soon one of the trapped person's limbs has been freed. [ncbi.nlm.nih.gov]

  Crush syndrome was clearly a major problem after the Armenian earthquake in 1988 2 3 4 5 and to a lesser extent after the 1985 earthquake in Mexico City 6, 7 —two events that were characterized by the collapse of multistory reinforced-concrete or stone [nejm.org]

  […] buildings, road traffic collisions) Compartment syndrome (alcohol-associated immobility, prolonged collapse, perioperative positioning, prolonged tourniquet use) Electrocution Non-traumatic Exertional (strenuous exercise, seizures) Body temperature changes [ceaccp.oxfordjournals.org]

  During the extrication of an injured person from a collapsed building, wrecked automobile, or other site, isotonic saline solution should be infused at the rate of 1.5 liters per hour as soon one of the trapped person’s limbs has been freed. [minervamedica.it]

• Camping

  A little more than a decade ago exertional rhabdo was rarely reported and was mostly associated with marathon runners and army training camps. [theconversation.com]

  Another well-known source of rhabdo cases is boot camp: “large numbers of [recruits] may have myoglobinemia … .” 21 After a bit of browsing through the literature, I have the impression that you could be rhabdo-ized by an especially hard sneeze. [painscience.com]

• Intravenous Administration

  administration, 011360, 投与経路, ﾄｳﾖｹｲﾛ, administration route, 054972, 投与, ﾄｳﾖ, administration(biology), 054973, administration [togodb.biosciencedbc.jp]

• Ecchymosis

  The physical presence of trauma or local sign of compression (erythema, ecchymosis, bullae, abrasion, etc) on a muscle mass should be evaluated. [physio-pedia.com]

• Hypotension

  As mentioned, permissive hypotension is unwise. [en.wikipedia.org]

  More recent studies using models of uncontrolled haemorrhage suggest an improved outcome with hypotensive resuscitation. [tra.sagepub.com]

  However, in view of acute onset of bronchospasm, facial oedema and hypotension possibility of anaphylactic reaction to undetected insect bite was considered in our patient. Rhabdomyolysis is not rare. [neurologyindia.com]

  Ischaemic renal dysfunction secondary to hypotension and diminished renal perfusion results in acute tubular necrosis and uraemia." [ 1 ] It is also known as Bywaters' syndrome. [patient.info]

  Normal saline - good volume expander if hypotensive/significantly dehydrated. Issues with this include the significant chloride load, which put patient at risk for metabolic acidosis. [morningreporttwh.blogspot.com]

• Irregular Heart Rhythm

  However, as reported in a recent review of exertional rhabdo, there are rare and extreme cases where exertional rhabdo has caused kidney failure, irregular heart rhythm, and death. How is it treated? Usual treatment is by oral or IV fluids. [theconversation.com]

• Flushing

  Prevention When engaging in highly strenuous activity it is crucial to consume plenty of fluids which will help to dilute the urine and flush away myoglobin. [healthguidance.org]

  Afterword: The flushing theory goes down the drain This entire article started out as an attempt to clarify a point about “flushing” in my article Water Fever and the Fear of Chronic Dehydration. [painscience.com]

  Treatment involves giving intravenous fluids to flush the myoglobin through the system, rehydrate the body and prevent kidney failure. If treatment isn't started quickly, injury to the kidneys can be permanent. [newsnetwork.mayoclinic.org]

  Prevention : Drink plenty of fluids after strenuous exercise to dilute the urine and flush the myoglobin out of the kidney. Proper hydration is also necessary after any condition or event that may involve damage to skeletal muscle. [crossfiteminence.com]

  These help the kidneys flush the myoglobin into the urine. Creatine levels are monitored until they go back to normal. [theconversation.com]

• Myopathy

  ) muscular dystrophies and myopathies ( G71 - G72 ) myopathy in amyloidosis ( E85.- ) myopathy in polyarteritis nodosa ( M30.0 ) myopathy in rheumatoid arthritis ( M05.32 ) myopathy in scleroderma ( M34.- ) myopathy in Sjögren's syndrome ( M35.03 ) [icd10data.com]

  It can be induced by numerous factors, including a crush injury to a limb, overuse of skeletal muscle, heat, alcoholism, viral infections, metabolic disorders, myopathies, drugs, toxins, and hypokalemia. [nejm.org]

  Longer-term myalgias may be indicative of a metabolic myopathy, some nutritional deficiencies or chronic fatigue syndrome. [dbpedia.org]

  Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. [pubfacts.com]

• Muscle Weakness

  Twelve patients presented with muscular pain and seven patients with muscle weakness. Twenty eight patients had urinalysis and five of them (18%) had negative orthotolidine dipstick test. [ncbi.nlm.nih.gov]

  Symptoms The symptoms of rhabdomyolysis include dark red coloured urine, decreased urination and muscle weakness and aching. It may also cause general fatigue, joint pain, seizure and weight gain. [healthguidance.org]

  Symptoms of rhabdomyolysis include extremely painful muscle aches, muscle weakness, and dark or cola-colored urine. Rhabdomyolysis requires immediate medical attention, and people who have this condition are usually hospitalized. [newsnetwork.mayoclinic.org]

  […] classified, left ankle and foot M62.579 Muscle wasting and atrophy, not elsewhere classified, unspecified ankle and foot M62.8 Other specified disorders of muscle M62.81 Muscle weakness (generalized) M62.82 Rhabdomyolysis M62.89 Other specified disorders [icd10data.com]

  The “classic triad” of rhabdomyolysis symptoms are: muscle pain in the shoulders, thighs, or lower back; muscle weakness or trouble moving arms and legs; and dark red or brown urine or decreased urination. [webmd.com]

• Muscle Swelling

  Lethargy or coma was present in 17 patients and muscle swelling in 11. Evidence of rhabdomyolysis included markedly elevated creatine phosphokinase, myoglobinuria, and aldolase in blood. [annals.org]

  Crush injury is compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances in the affected areas of the body, while crush syndrome is localized crush injury with systemic manifestations. [en.wikipedia.org]

  Crush Injury: Compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances. Crush Syndrome: Crush injury with systemic manifestations. [clinicaladvisor.com]

  […] soreness, and swelling Initiation of physical activity: foam rolling, dynamic warm-up, aquatic jogging, and stretching Phase 3: Activities Daily monitoring of hydration status, muscle soreness, and swelling Progression of physical activity: body-weight [physio-pedia.com]

• Contusion

  Anesthetic complications during emergency noncardiac surgery in patients with documented cardiac contusions. J Cardiothorac Vasc Anesth 1991 ; 5 : 57 -60. ↵ Baker SP, O’Neill B, Haddon W, Long WB. [clinchem.aaccjnls.org]

  Formulation in Different Clinical Situations 269 Methods to Decrease Risk of Aspiration 272 Severe Preeclampsia and Eclampsia 275 Sepsis Severe Sepsis and Septic Shock 284 Acute Respiratory Distress Syndrome 295 Appendices IXIII Flail Chest and Pulmonary Contusion [books.google.com]

• Suggestibility

  On the other hand other surgeons suggest doing a fasciotomy only in selected group of patients. Therefore, the traumatic rhabdomyolysis has few diagnostically problems. [ncbi.nlm.nih.gov]

  A history of prolonged limb compression with a swollen limb should suggest the diagnosis of crush syndrome. [archsurg.jamanetwork.com]

  IXIII Flail Chest and Pulmonary Contusion 304 Acute Respiratory Failure due to Chronic 0bstructive Pulmonary Disease 313 Acute Severe Asthma in Adults 326 Diabetic Ketoacidosis 336 GuillainBarre Syndrome 344 Conversion Factors for Important Minerals 369 Suggested [books.google.com]

  […] rubble who suffer from extensive muscle damage and its devastating sequelae of hemodynamic and metabolic disturbances and acute renal failure. 1 We review here the pathogenesis of shock and acute renal failure associated with traumatic rhabdomyolysis and suggest [nejm.org]

• Kidney Failure

  Kellum Springer Science & Business Media, ١١‏/٠٣‏/٢٠١٠ - 678 من الصفحات Acute kidney failure is an important clinical area in the intensive care unit setting. [books.google.com]

  Myoglobin, when it reaches the kidneys, can block the tiny tubes within the kidneys, leading to serious kidney damage and, in some cases, kidney failure. [newsnetwork.mayoclinic.org]

  Kidney failure should also be treated. The outcome depends on the amount of kidney damage. Acute kidney failure occurs in many people. Getting treated soon after rhabdomyolysis will reduce the risk of permanent kidney damage. [medlineplus.gov]

  Prompt treatment could prevent the condition from progressing to a stage of permanent kidney damage It is crucial to seek medical attention as soon as possible to prevent kidney failure and to improve one’s chances of a recovery. [dovemed.com]

  Kidney failure caused by rhabdomyolysis may produce life-threatening hyperkalemia and metabolic acidosis. [medical-dictionary.thefreedictionary.com]

• Oliguria

  The median oliguric period in the dialysed patients was 9 (IQR 11), (range: 0–37) days and 397 (89.8%) of these patients had oliguria for at least 1 day, while only 17.8% of the non‐dialysed patients experienced 1 or more days of oliguria. [ndt.oxfordjournals.org]

  Features include myoglobinuria and typical lower nephron nephrosis with oliguria or anuria. Pain where trauma has occurred. Cases commonly occur in catastrophes such as earthquakes or war, where victims have been trapped under fallen masonry. [whonamedit.com]

  Reperfusion syndrome → compartment syndrome References: [4] [1] Clinical features Rhabdomyolysis Classic triad Myalgia Generalized weakness Darkened urine (red to brown) Nonspecific symptoms : fever ;, nausea, vomiting Complications Acute kidney injury : oliguria [amboss.com]

  Dialysis and Hemofiltration Oliguria or anuria responsive to treatment, fluid therapy, volume overload, and a rising serum potassium (47 mEq/L) are indicators of the need for dialysis. [clinicaladvisor.com]

  There was no history of fever, injury, loose motions, oliguria or overt snake or insect bite. He had no prior history of systemic disease, fever, recurrent abdominal pain, neuro-muscular dysfunction or allergic disorder. [neurologyindia.com]

• Renal Insufficiency

  American Journal of Medicine, 18, 187-198. http://dx.doi.org/10.1016/0002-9343(55)90234-5 [ 17 ] Stone, W. and Knepshield, J. (1974) Post Traumatic Acute Renal Insufficiency in Vietnam. [scirp.org]

  This releases large amounts of myoglobin, which reach the kidneys via the bloodstream where it can cause major damage, including acute renal insufficiency. In this case medical attention is absolutely and immediately necessary! [freeletics.com]

  insufficiency or failure. • This abnormality may cause life-threatening arrhythmias and should be immediately addressed. 24. • Hypocalcemia is another common metabolic abnormality, resulting from deposition of calcium phosphate. • It may also be due [slideshare.net]

  If given enough time, many patients partially or completely recover renal function. The chances of recovery are obviously much higher in the absence of preexisting renal insufficiency. [aafp.org]

  Phosphorus is released from damaged muscle and accumulates in patients with renal insufficiency. [jasn.asnjournals.org]

• Hematuria

  Only seven patients (25%) were detected positive orthotolidine test without microscopic hematuria. Patients with acute renal failure had higher levels of potassium and uric acid. [ncbi.nlm.nih.gov]

  Urinary myoglobin provokes a typical reddish-brown (port-wine-like) color, even in the absence of hematuria ( Table 3 ). [jasn.asnjournals.org]

  • A urine myoglobin assay is helpful in patients with coexisting hematuria (confirmed with microscopic examination) when the presence of myoglobin is suspected. 34. • A urine dipstick test for blood that has positive findings in the absence of red blood [slideshare.net]

  Causes of Reddish-Brown Discoloration of the Urine [4] Myoglobinuria Rhabdomyolysis Traumatic Non-Traumatic Hemoglobinuria Hemolysis Mechanical Damage Immunologic Damage Structural Fragility of Erythrocytes Microangiopathy Hematuria Courtesy of: Vanholder [physio-pedia.com]

• Lethargy

  Lethargy or coma was present in 17 patients and muscle swelling in 11. Evidence of rhabdomyolysis included markedly elevated creatine phosphokinase, myoglobinuria, and aldolase in blood. [annals.org]

  Patients may also experience nausea and lethargy. What causes it? There are two main ways enough cells can be damaged to cause systemic problems. The first way is crush injuries from direct rupture of the cell walls. [theconversation.com]

  Symptoms related to the expected complications of rhabdomyolysis include: symptoms of kidney failure, which may include swelling of the hands and feet; shortness of breath as excess fluid builds up in the lungs, lethargy; weakness; symptoms of hyperkalemia [medicinenet.com]

• Convulsions

  Os I, Lyngdal PT : Generalized convulsions and rhabdomyolysis. Acta Neurol Scand 1989; 79 : 246-248. 6. Chugh KS, Singhal PC, Khatri GK : Rhabdomyolysis and renal failure following status asthmaticus. Chest 1978; 73 : 879-880. 7. [neurologyindia.com]

  […] demographic (age and gender) and comorbidity (Charlson comorbidity index and arterial hypertension) variables, risk factors related in the literature to rhabdomyolysis (muscular necrosis, obesity, consumption of statins, antipsychotics, sedatives or alcohol, convulsions [ijccm.org]

• Paresis

  There was no ptosis, ophthalmoplegia or facial paresis. He had marked stiffness of jaw muscles and could open the mouth only with great difficulty. His voice was of low volume and had nasal twang. The palatal and gag reflexes were sluggish. [neurologyindia.com]

Myoglobinuria, workup. Medscape. Available online at https://emedicine.medscape.com/article/982711-workup. Accessed on 9/2/2019. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. [labtestsonline.it]

Rhabdomyolysis: Differential Diagnoses and Workup. eMedicine 2009. ↑ Baxter R, Moore J. Diagnosis and Treatment of Acute Exertional Rhabdomyolysis. Journal of Orthopaedic and Sports Physical Therapy 2003; 33(3): 104-108 [physio-pedia.com]

Magnetic resonance imaging (MRI; assessment of myopathy) Other tests that may be considered include the following: Electrocardiography (ECG) Measurement of compartment pressures Muscle biopsy Immunoblotting, immunofluorescence, and genetic studies See Workup [emedicine.medscape.com]

• Hyperuricemia

  The disease has good prognosis despite severe hypercatabolism and untreated profound hyperuricemia. FULL TEXT [annals.org]

  Acute kidney injury Acute tubular necrosis Compartment syndrome Disseminated intravascular coagulation Hepatic insufficiency Arrhythmias Electrolyte abnormalities, such as hyperphosphatemia, hyperkalemia, hypocalcemia (early), hypercalcemia (late), hyperuricemia [quizlet.com]

  Complications • Electrolyte abnormalities are prominent features of rhabdomyolysis: – Hyperphosphatemia – hyperkalemia – hypocalcemia (early) – hypercalcemia (late) – Hyperuricemia – hypoalbuminemia 23. • Hyperkalemia may be a result of both muscle injury [slideshare.net]

  Hyperuricemia, which tends to be much higher in patients with exertional rhabdomyolysis, results from purines released from injured muscle cells. [ahcmedia.com]

  […] tissue swelling Skin changes consistent with pressure necrosis Hyperthermia, hypothermia, and electrical injuries Crush injuries or deformities in long bones Complications of rhabdomyolysis include the following: Electrolyte abnormalities Hypoalbuminemia Hyperuricemia [emedicine.medscape.com]

• Creatinine Increased

  increased 1.5-fold or glomerular filtration rate (GFR) decreased > 25%, “injury” if serum creatinine increased 2-fold or GFR decreased > 50%, and “failure” if serum creatinine increased 3-fold or GFR decreased > 75%. [journals.plos.org]

Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe. [ncbi.nlm.nih.gov]

Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual. [books.google.com]

The disease has good prognosis despite severe hypercatabolism and untreated profound hyperuricemia. FULL TEXT [annals.org]

OBJECTIVES: We assessed identification and management of these patients, considering: (i) early adverse parameters used to identify poor prognosis, (ii) the importance of early recognition, and (iii) appropriate management with aggressive fluid therapy [ncbi.nlm.nih.gov]

DOI: 10.1007/BF00200505 Rhabdomyolysis with myoglobinuria and acute renal failure can develop from a variety of traumatic and nontraumatic reasons and the clinical as well as forensic significance of it may vary from an epiphenomenon with an excellent prognosis [semanticscholar.org]

The prognosis for recovery will depend on the amount of kidney damage, which often depend on how early the symptoms were identified. Those with mild cases should be able to resume normal activity within a few weeks to a month. [healthguidance.org]

Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed. [ncbi.nlm.nih.gov]

The most common causes are muscle overextension, muscle compression and crush injury, but there are also numerous non-traumatic etiologies. The latter group can be broadly divided into toxic, infectious and metabolic causes. [news-medical.net]

[…] synonyms: Rhabdomyolysis ICD-10 M62.82 - Rhabdomyolysis Rhabdomyolysis ICD-9 728.88 Rhabdomyolysis 728.88 Etiology / Epidemiology / Natural History muscle necrosis causing the release of myoglobin into the bloodstream. [eorif.com]

Topics for discussion • Background • Pathophysiology • Etiology • Prognosis • Clinical Features • Differential Diagnosis • Management 3. [slideshare.net]

Written by internationally renowned experts, this clinical reference offers helpful advice with the most recent information on the definition, epidemiology, pathophysiology, and clinical causes of acute kidney failure as a fundamental prerequisite for [books.google.com]

[…] synonyms: Rhabdomyolysis ICD-10 M62.82 - Rhabdomyolysis Rhabdomyolysis ICD-9 728.88 Rhabdomyolysis 728.88 Etiology / Epidemiology / Natural History muscle necrosis causing the release of myoglobin into the bloodstream. [eorif.com]

Prognostic and epidemiologic study, level III. Supplemental digital content is available in the text. [journals.lww.com]

Renal failure, 23, 183-191. http://dx.doi.org/10.1081/JDI-100103490 [ 21 ] Sever, M., Erek, E., Vanholder, R., Akoglu, E., Yavaz, M., Ergin, H., Tekce, M., Korular, D., Tulbek, M., Keven, K., et al. (2001) The Marmara Earthquake: Epidemiological Analysis [scirp.org]

We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management. Copyright © 2017 The Canadian Society of Clinical Chemists. [ncbi.nlm.nih.gov]

Written by internationally renowned experts, this clinical reference offers helpful advice with the most recent information on the definition, epidemiology, pathophysiology, and clinical causes of acute kidney failure as a fundamental prerequisite for [books.google.com]

The pathophysiology of rhabdomyolysis must be understood on cellular (microscopic) and muscle compartment (macroscopic) levels. [ahcmedia.com]

Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe. [ncbi.nlm.nih.gov]

[…] of muscle tissue & influx of myoglobin, potassium, and phosphorus into the circulation; - syndrome is characterized by hypovolemic shock and hyperkalemia ; - these results strongly suggest that free-radical scavengers are beneficial in attenuating or preventing [wheelessonline.com]

It also prevents neutrophil adhesion and prevents secondary injury. It is directly bactericidal to anaerobic organisms. [clinicaladvisor.com]